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The dental trifecta

Dec. 1, 2020
You continually need new patients. You need to have good case acceptance. You must often battle insurance companies. Here was Dr. Michael Tornow has learned about each of these as a private practice dentist.

In 2001, I was a young dentist and captain in the United States Air Force. While I was enjoying my time in the service, I knew my tour of duty would end in 2004. So over the next few years I prepared to begin my private practice career. I learned as much as possible about what to expect in the future. Dental Economics was a trusted source.

Like so many others, I did not fully understand the roles I would be taking on as a private practice owner: I would be a practitioner. I would be a team coach. I would be the CEO, CFO, CMO, bookkeeper, and HR director. It was not easy at first. At times it was even overwhelming. Eventually I brought on additional team members to perform the different roles in the practice and take duties off my plate.

Over the years, three important truisms became apparent in my practice. They are still true today:

  • You continually need new patients.
  • You need to have good case acceptance.
  • You oftentimes must battle insurance companies and patients to receive reimbursement for services rendered.

I would like to share what I have learned about each of these.

New patients

The acquisition of new patients has evolved over time. In my experience, a practice needs 20 to 35 new patients per doctor per month. This accounts for patient attrition.

In 2004, the big push for new patients involved print ads. Dentists such as myself primarily used the yellow pages and local newspaper. The yellow pages involved having a large ad. Dentists would start off with a small ad, then move to a half-page ad, then to a full-page ad, and then a “double-truck” ad. There were also two yellow page companies. It seemed about half of the general public used one book and half the other.  Newspaper advertising required a certain number of columns. The decision had to be made about running a black and white ad or color ad. Both forms of media advertisement were expensive. 

Marketing has evolved from print media to digital media. We have Facebook, Google Ads, and web design. These consume the majority of our dollars. There are patient reviews to request and then to contend with should they be negative.  It’s not the same advertising game in 2020 as it was 16 years ago. I’m sure it will continue to evolve. 

Dental case acceptance

Case acceptance is tricky. It is also an underappreciated key performance indicator. We all survive and complete dental school. We learn a new vernacular to help us communicate as professionals. We also make assumptions that patients understand certain dental concepts and verbiage. We erroneously think that all patients understand what a simple cavity is, or an abscess, or pocket depths, or dental implants, or IV sedation, or wisdom teeth removal, or crown preparation . . . 

My experience suggests that a good 90% of patients don’t completely understand what we as dental professionals are communicating. The word “doctor” should really mean “educator.” However, we often lack the time or skill to make education happen. If we recall our dental school experiences, it is probably safe to say that we did not take Patient Psychology 101 or Advanced Patient Education 350. These courses would have been nice. 

What I have learned over the years is that verbiage is important in educating and discussing dental topics with patients. Clear communication can also be learned.

The concept of “a picture is worth a thousand words” is true. I have taken this concept one step further and say that “a model is worth a thousand words.” I use certain models that I have in a kit in each operatory to show and demonstrate dental procedures and concepts to my patients.

In September 2015, there was a brilliant Dental Economics article by Jim Philhower, a 28-year veteran of Henry Schein and regular contributor to the magazine.1 In his article, he said that of thousands of dental offices studied, case acceptance rates were 25%–35% for new patients and 50%–60% for patients of record. Yet dentists erroneously thought their case acceptance was much higher. 

Most dentists don’t give much thought to case acceptance. Perhaps they are so busy that it is not an important key performance indicator to them or they inadvertently ignore it.

During my years in practice, I have become a student of case acceptance and tracked my data. I don’t believe it is ever possible to achieve 100% case acceptance. The biggest obstacle is money. Patients may simply not have money or they lack access to credit to pay for services. My case acceptance has been 80% or greater over the last several years. I have also been able to coach associates to achieve the same.

Reimbursement for dental services

It is important for a dental practice to track its reimbursement rates relative to production. You must look at adjusted production versus collections. Here are two illustrative examples.

Example no. 1

Let’s assume I’m charging $1,200 for a crown. However, I’m contracted with the insurance company to perform the service for $800. The crown is covered at 50%. The insurance company pays $400 and the patient pays her $400 portion. If you divide $800 by $1,200 you would assume that your collections are only 66.7%. In my office we track adjusted production. In this situation we really billed out $800. We received $800. This is 100% collections versus production.

Example no. 2

Let’s take a similar case. $800 is billed out for the crown. The patient pays $400. The insurance company disagrees with the need for the crown, so they deny payment of the claim. $400 divided by $800 is 50% collections versus production.

In talking with CEO Daniel Ichelson of Dental Accounts at Ease, the dental office may or may not try to seek reimbursement of the rejected claim. The practice may simply be too busy. The insurance biller in the practice could be overwhelmed. Maybe he or she resubmits the claim several times. The claim is rejected a second or third time by the insurance company. The dental practice then decides that it is too time-consuming and not worth more attempts to seek reimbursement for the claim. This can really skew the collections versus production ratios data. 

Ms. Ichelson’s opinion is that a dental practice should be collecting 97% or more of its billable, adjusted production. Her company takes over the insurance billing in a dental practice. It has been financially helpful in my practice to employ her services.


I call the marketing for new patients, the emphasis on case acceptance, and the collection of adjusted production “the dental trifecta.” The mastery of these three aspects of dentistry will allow you to have greater success and fulfillment in this great profession. Remember new patients, case acceptance, and getting paid. Onward and upward!


1. Philhower J. Measuring Case Acceptance. Dental Economics. September 2015. http://digital.dentaleconomics.com/dentaleconomics/201509?pg=64#pg64

MICHAEL TORNOW, DDS, graduated from Oregon Health Sciences University in 2001. He is a practicing dentist and multipractice owner in Utah. He loves to coach dentists and their teams. He can be contacted at [email protected].

About the Author

Michael Tornow, DDS

MICHAEL TORNOW, DDS, graduated from Oregon Health Sciences University in 2001. He is a practicing dentist and multipractice owner in Utah. He loves to coach dentists and their teams. He can be contacted at [email protected].

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